Valvular & structural heart diseaseCohort study
Degenerative mitral regurgitation due to flail leaflet: sex-related differences in presentation, management, and outcomes
- Registry-based cohort study
- international registry
Authors' conclusion
Females with severe DMR were referred to tertiary centers at a more advanced stage, incurred higher mortality and morbidity under conservative management, and were offered surgery less and later after referral. Ultimately, these sex-related differences yielded persistent excess mortality despite surgery in females with DMR, while males enjoyed restoration of life expectancy
Study context
- Population
- Patients referred for degenerative mitral regurgitation due to flail leaflets (MIDA international registry)
- Participants
- 650 vs 1,660
- Exposure
- Females vs males
- Femalesn = 650
- Malesn = 1,660reference
- Outcome
- Outcome (survival/HF) under medical treatment, post-operatively and throughout follow-up
Main finding
As reported in the abstract
Mortality under conservative (medical) management
| Group | Standardized mortality ratio (SMR) vs expected |
|---|---|
| Females | 2.00 (1.67-2.38), P < .001 |
| Males | 1.45 (1.27-1.65), P < .001 |
- Female sex independently associated with mortality under medical management: adjusted HR (1.04-1.61)
- 1.29, P = .02
- Female sex independently associated with CV mortality under medical management: adjusted HR (1.14-2.18)
- 1.58, P = .007
- Female sex independently associated with HF under medical management: adjusted HR (1.02-1.81)
- 1.36, P = .04
Observational data: associations, not effects.
Further findings
Offered surgical correction
P < 0.001
| Outcome | Females | Males | P value |
|---|---|---|---|
| Overall mortality vs expected throughout follow-up | |||
| SMR | 1.31 (1.16-1.47), P < .001 | 0.92 (0.85-0.99), P = .036 |
Surgical outcome (adjusted for presentation)
- Similar in females and males
- P ≥ 0.09
Original publication
Degenerative mitral regurgitation due to flail leaflet: sex-related differences in presentation, management, and outcomes. Eur Heart J. Published 16 May 2024. doi:10.1093/eurheartj/ehae265
Summarised from the published abstract; every number is checked against it